Provider Demographics
NPI:1003668211
Name:CHIVERS, FOSTON YAEGER (LMT)
Entity Type:Individual
Prefix:
First Name:FOSTON
Middle Name:YAEGER
Last Name:CHIVERS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 E TERRA SOL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5088
Mailing Address - Country:US
Mailing Address - Phone:801-875-9952
Mailing Address - Fax:
Practice Address - Street 1:47 E FORT UNION BLVD STE 203
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5507
Practice Address - Country:US
Practice Address - Phone:801-875-9952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8427196-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist